Circulating Adhesion Molecules in Pediatric Cardiac Surgery

Abstract

Cardiopulmonary bypass (CPB) may be associated with the risk of a "whole body inflammation." Adhesion molecules, such as endothelial leukocyte adhesion molecule (ELAM-1), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1), seem to play a pivotal role in the inflammatory response. Soluble forms of these adhesion molecules may serve as markers of endothelial activation or damage. To elucidate whether plasma levels of soluble adhesion molecules differ between pediatric and adult cardiac surgery patients, 15 consecutive children younger than 5 yr undergoing CPB were prospectively studied and compared with adults scheduled for elective coronary artery bypass grafting and valve replacement. Plasma levels of circulating (soluble) adhesion molecules (sELAM-1, sICAM-1, sVCAM-1) were measured from arterial blood samples using enzyme-linked immunosorbent assays after induction of anesthesia (= "baseline"), during CPB, at the end of surgery, and on postoperative days 1 and 2. At baseline, plasma levels of all three soluble adhesion molecules were significantly higher in children than in adults. sELAM-1 and sICAM-1 plasma concentrations were even beyond normal in the children (sELAM-1: 88.8 +/- 13.8 ng/mL; sICAM-1: 349 +/- 27 ng/mL). During CPB and until the end of surgery, plasma levels of all adhesion molecules decreased in the children and remained almost unchanged in the adults. In the children, sELAM-1 remained lower than baseline values until the second postoperative day (45.2 +/- 12.2 ng/mL), whereas sICAM-1 increased in the postbypass period without, however, reaching baseline values (254 +/- 40 ng/mL).(ABSTRACT TRUNCATED AT 250 WORDS)

Complement Activation, Cytokines, and Adhesion Molecules in Children Undergoing Cardiac Surgery with or without Cardiopulmonary Bypass

“…Postoperatively the ICAM-1 decrease is even more pronounced in the CPB group than in the control. This finding is in agreement with data reported for adults [3] and children [2] that indicate that anesthesia and surgery reduce endothelial activation.…”

“…Indirect evidence for these processes would be the elevated release of endothelial selectin (E-selectin and ELAM-1), an adhesion molecule on endothelial cells and ICAM-1, an adhesion molecule, among others, on leukocytes [13]. Our data on preoperative serum levels of both molecules are in agreement with published data for children with congenital heart disease [2], and serum levels in our data were higher than those of the published data in adults [3]. Our results show that soluble adhesion molecule levels decrease as the effect of surgery.…”

“…Therefore, our sampling point at +4 hours overlaps that from the other studies (except Ref. [2]) and should at least detect the decline of IL-8. Only a few children from our study show a massive increase in serum IL-8 levels and 5/18 children from the CPB group 123 Tárnok et al: Effect of CPB did not show any detectable IL-8 release.…”

“…Therefore, stimulation of the complement system during CPB by contact with foreign surfaces leads to several specific alterations at the cellular and humoral level, including removal of neutrophils and other leukocytes from the blood circulation, histamine release, and increased levels of interleukin-1 (IL-1), IL-6, and IL-8 [10][11][12]17]. The leukocyte removal is also reflected by alterations in the serum level of soluble cellular adhesion molecules from the peripheral blood [14], for example, the intercellular adhesion molecule-1 (sICAM-1, CD54) and endothelia leukocyte adhesion molecule (ELAM-1 or sE-Selectin, CD62E) [2,3].…”

The effects of circulating interleukin-8 and adhesion molecules on pulmonary dysfunction in pediatric orthotopic liver transplantation

“…The findings of this study indicate that endothelial abnormality of the damaged liver might produce an increase in local adhesion molecules, which could result in the elevation of a circulating adhesion molecule concentration. The same results were reported by a study on circulating adhesion molecules in pediatric congenital heart disease patients, 15 according to which, circulating adhesion molecules had no effect on respiratory function after successful cardiac surgery. 15 Circulating adhesion molecules may not have as important a role as adhesion molecules at inflammation sites.…”